If you have diabetes and have been prescribed steroid medication, you have probably found out first-hand the effect this medication can have on your blood glucose level. It is important to be well informed of the possible side effects prior to starting any steroid medication, including the impact it may have on your diabetes.

More recently, treatment regimes for Covid-19 can involve high doses of steroids which not only affect people who already have diabetes, but put some people at risk of developing steroid-induced diabetes.

What are steroids prescribed for?

Corticosteroids (steroids) are hormones similar to those naturally occurring in your body that are produced in response to stress, injury and disease. Steroid medications are prescribed for their anti-inflammatory effect in the body and their ability to suppress the immune system.

Steroids are commonly used to treat:

• Inflammatory bowel diseases (for example Crohn’s disease, ulcerative colitis)
• Autoimmune diseases (for example lupus)
• Joint and muscle disease (for example rheumatoid arthritis, polymyalgia rheumatica PMR)
• Allergies and asthma
• Covid-19

Steroids are also useful to prevent nausea during medical procedures such as chemotherapy.

These steroids are different to the anabolic steroids that are used to build muscle mass.

How steroids affect your blood glucose levels

If you have type 1 or type 2 diabetes, taking steroids could make it harder for you to control your diabetes. Steroids raise your blood glucose levels in the following ways:

• They block the action of insulin which causes insulin resistance
• Less glucose is taken up by the muscles from the bloodstream
• They cause the liver to start releasing extra glucose into the bloodstream

Steroids are available in different forms

• Tablets (oral steroids)
• Injections – which can be into blood vessels, joints or muscles
• Inhalers – such as mouth or nasal sprays
• Lotions, gels or creams (topical steroids)

Inhaled steroids used for asthma do not affect blood glucose levels.

Oral steroids will have an affect depending on time, dose and type of steroid you are taking. These effects may be seen in your blood glucose readings a few days after commencement.

Injectable steroids can cause blood glucose readings to rise soon after administration and the effects may last from three to 10 days.

Other side effects

Other side effects of steroid medication that relate to your diabetes management could include:

• Increased hunger
• Weight gain
• Urinary tract infections
• Increased blood pressure
• Skin problems such as poor wound healing after injuries, thinning skin and easy bruising.

It is important to take your steroid medication when it is prescribed by your doctor, even if it does make your diabetes more difficult to control.

Here are some tips if you need to start steroid medication

• Get advice from your doctor or diabetes educator on how to adjust your insulin or diabetes medication while on steroid therapy
• Increase the number of times you test your blood glucose levels and record all results so you can show your doctor or diabetes educator
• Do regular physical activity
• Follow a healthy eating plan
• See a dietitian to discuss good food choices
• Ask your doctor about a home medication review (HMR) where a pharmacist will review your medication regimen in a home visit, provide education to you about your condition and the appropriate use of all your medication, including both prescription and non-prescription medication

Useful things to remember when starting steroid medication

• Never stop taking your steroid medication abruptly, dosage should only be reduced by your doctor over a gradual period of time
• The effects of steroid medication can stop within 48 hours of ceasing the medication
• The effects of injections can last between three to 10 days
• Steroids can raise your blood glucose levels therefore you should test your blood glucose more frequently and seek advice from your doctor or diabetes educator
• If you are on long-term steroid treatment you may consider wearing a medical identification bracelet

Steroid-induced diabetes

Steroids are commonly prescribed for certain medical conditions and make up an important part of a person’s treatment. While steroids are necessary, it is also important to understand there is a risk of developing diabetes with long-term use of steroids.

Covid-19 is one medical condition that is treated with high dose steroids such as Dexamethasone. As a result, there have been a number of people with steroid-induced diabetes resulting from Covid-19 treatment. Managing high blood glucose levels is necessary and must be immediate to improve and reduce the risks of complications. If you have been diagnosed with steroid-induced diabetes you can register with the NDSS (National Diabetes Services Scheme) to access a range of subsidised diabetes products and support to self-manage your condition.

Credentialled Diabetes Educator, Suzanne Leahy